The effect of thoracic manipulations in patients with neck pains

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This should be a short section setting the scene and defining and outlining the main themes which should include your chosen clinical group, e.g. Whiplash clinical features, the current evidence of assessment and management relating to this group, clinical governance issues and the specific manual techniques that you have chosen.

Main Body

In this section you should include the clinical factors, societal, NHS costs and clinical governance issues relating to your allocated patient group. What are the symptoms/problems that these patients would present with? What are the standard assessment and screening procedures for these patients prior to management? How do the manual techniques relieve some of these in terms of physiological effects and how were these measured in terms of validated outcome measures such as pain or function e.t.c.? You need to back up your statements with evidence for this.

For cognitive ability and clinical reasoning you should relate the literature that you will review to clinical practice and synthesise or sum up the information as appropriate.

In this section you should briefly discuss a few key papers that focus upon your subgroup and specific manual therapy modalities. This will give an indication of the expected quality of your literature review. Try to choose the most relevant and contemporary papers that you have found so far and comment on the quality of the papers with respect to design, population, etc. You may include specific NICE / CSP guidelines. In order to achieve higher marks you can use the evidence and clinical reasoning to challenge the established guidelines. You should further develop the use of appraisal in terms of the inclusion criteria for example was the population a homogeneous group or were there many variables such as including patients with different pathologies or differences in terms of chronicity e.t.c. Was the treatment standardised and easy to follow or repeat or was it ambiguous or may have differed from patient to patient? Was the intervention carried out by the same clinician? Was the assessor blinded to the intervention? How can the research be directed in the future to reduce bias and improve the validity of the studies? How can the research be conducted to better inform clinical practice?

Please ensure that you use good, academic language throughout to improve the clarity of your written work.


The conclusion is a concise summary of your main findings. It should not introduce any new themes or arguments. Have you developed an argument to support the use of the manual techniques for these patients based on the evaluation and summary of the literature? Did you conclude that manual therapy was effective when used with other management strategies such as exercise or education? How should future studies be carried out to improve evidence based practice?


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